Diverticular disease presenting as subcutaneous emphysema of the thigh.

A normally fit and well 79-year-old lady presented acutely confused and shocked after a few months history of atypical left-sided back and thigh pain. She was unable to tolerate movement of her left leg and soft tissue crepitus was palpable over her thigh. Emergency incision and drainage of the leg was performed with intraoperative swabs growing Streptococcusmilleri and coliforms. Postoperatively, in the Intensive Care Unit (ICU) deep faecal contamination of the wound was noted. Contrast imaging revealed severe diverticular disease and colocutaneous fistula. Abdominal examination was unremarkable throughout her admission and initial CT scan had not revealed the underlying pathology. A defunctioning colostomy was fashioned and after a prolonged period of rehabilitation the patient returned to being functionally independent.